Clinical Endoscopy

Systematic Review and Meta-analysises

Comparative efficacy and safety of supine versus prone positioning in endoscopic retrograde cholangiopancreatography: a systematic review and meta-analysis: Fariha Hasan, Muhammad Shahzil, Ayesha Liaquat, Taha Bin Arif, Muhammad Yafaa Naveed Chaudhary, Eugene Annor, Dushyant Singh Dahiya, Jay Patel, Rohini Maddigunta, Avneet Singh, Alexander Garcia, Babu P. Mohan, Rachel Frank, Adib Chaaya; Clin Endosc 2025;58(6):843-853. Published online August 26, 2025; DOI: https://doi.org/10.5946/ce.2025.072

Graphical Abstract Abstract PDF Supplementary Material: Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position (PP). Recent studies have shown that the supine position (SP) is an effective alternative, with comparable success rates. We conducted a meta-analysis to directly compare the safety and efficacy of the two ERCP positions.
Methods
In line with Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed through a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan, with results considered significant at p<0.05 and reported as odds ratios (ORs) and mean differences (MDs).
Results
Eleven studies (24,285 patients) were included in the final analysis. Procedural success was significantly higher in the PP (OR, 0.52; 95% confidence interval [CI], 0.36–0.75; p<0.0004) than the SP. However, no significant difference was observed in procedure times (MD, 0.22; 95% CI, –7.07 to 7.50; p=0.95), number of cardiopulmonary complications (OR, 1.08; 95% CI, 0.47–2.48; p=0.86), or post-ERCP pancreatitis (OR, 1.12; 95% CI, 0.52–2.42; p=0.31) between the two groups.
Conclusions
The PP demonstrates superior ERCP success compared to the SP, without prolonging procedure time or increasing the risk of adverse events. However, given the comparable procedure times, incidence of adverse events, and increased comfort for both patients and anesthesiologists, the SP may be a suitable alternative for a select group of patients in whom the PP is not feasible, such as those with morbid obesity or recent abdominal surgery.

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Pre-endoscopy erythromycin versus metoclopramide for upper gastrointestinal bleeding: a systematic review and network meta-analysis: Ravi Teja Pasam, Kanwal Bains, Srilekha Chava, Babu P. Mohan; Clin Endosc 2025;58(6):831-842. Published online July 4, 2025; DOI: https://doi.org/10.5946/ce.2024.351

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Given the limited head-to-head trials comparing the outcomes of pre-endoscopy erythromycin and metoclopramide for upper gastrointestinal bleeding (UGIB), a network meta-analysis (NMA) and component NMA were conducted.
Methods
A comprehensive review of the Medline, Embase, and Cochrane databases was conducted for randomized controlled trials comparing pre-endoscopy erythromycin or metoclopramide for UGIB with or without gastric lavage (GL) to placebo and/or GL. The primary outcome was the adequate visualization of the mucosa. The secondary outcomes were endoscopy visualization score, endoscopy duration, diagnosis established at initial endoscopy, second-look endoscopy, blood transfusions, mortality, and duration of hospitalization.
Results
A total of 16 studies (1,447 patients) were included. No significant differences were observed between erythromycin and metoclopramide in all the outcomes, but erythromycin had significantly better outcomes than the control group in terms of endoscopic visualization score (standardized mean difference, 0.58; 95% confidence interval [CI], 0.26–0.91), adequate mucosal visualization (risk ratio, 1.55; 95% CI, 1.18–2.04), second-look endoscopy, transfusion requirements, and duration of hospitalization. Component network meta-analysis revealed that erythromycin, but not metoclopramide or GL, provided significantly better endoscopic visualization than the placebo.
Conclusions
Erythromycin should be considered before UGIB endoscopy. The current data do not support the use of metoclopramide or GL.

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Endoscopic Treatment of Upper Gastrointestinal Bleeding
Yu Jin Kim, Heung Up Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2026; 26(2): 131. CrossRef

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Systematic Review and Meta-Analysis

Prevalence of intestinal metaplasia, dysplasia, and esophageal adenocarcinoma in patients with irregular Z-line: a systematic review and meta-analysis: Vishali Moond, Pradeep Yarra, Mannat Bhatia, Sheza Malik, Vineel Malavarappu, Hassam Ali, Saurabh Chandan, Douglas G. Adler, Babu P. Mohan; Clin Endosc 2025;58(3):377-385. Published online March 31, 2025; DOI: https://doi.org/10.5946/ce.2024.211

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line.
Methods
We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics.
Results
Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia.
Conclusions
Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.

Citations

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Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes
Natalie J. Wilson, Nicholas Mordan, Cole Potrock, Nicholas J. Shaheen
American Journal of Gastroenterology.2026; 121(2): 302. CrossRef
Barrett's Esophagus
Antonio Al Hazzouri, Philippe Attieh, Tony Azizi, Karl Kfoury, Kelly Katherine Karam, Karam Karam, Elias Fiani
Journal of Gastroenterology and Hepatology.2026; 41(1): 41. CrossRef

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Systematic Review and Meta-analysises

Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis: Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari; Clin Endosc 2025;58(2):240-252. Published online February 3, 2025; DOI: https://doi.org/10.5946/ce.2024.120

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

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Successful Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra‐thin Scope and Single‐balloon Overtube
Takato Maeda, Norihiro Hanabata, Shohei Igarashi, Masayoshi Ko, Koji Shimaya, Hiroshi Numao, Masaki Munakata, Hirotake Sakuraba
DEN Open.2026;[Epub] CrossRef
Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef
Minimally invasive, maximum impact: advances in the application of colonic stents
Filippos Koutroumpakis, Emmanuel Coronel
Current Opinion in Gastroenterology.2026; 42(1): 19. CrossRef
Causes of stenting complications for malignant colorectal stenosis in patients with acute obstructive colonic obstruction
Khosiyat T. Solijonova, I. A. Semenenko, A. E. Voynovskiy, P. A. Barbado Mamedova, O. V. Kanadashvili, G. V. Sinyavin, A. R. Iskandarova
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A Multicenter Prospective Study on the Safety and Efficacy of the New Low Axial Force Self‐Expandable Metallic Stent With Slim Delivery System for Malignant Colorectal Obstruction
Takeshi Mizumoto, Yuzuru Tamaru, Toshio Kuwai, Akihisa Matsuda, Shuji Saito, Satoshi Ikeda, Kazuhiro Hiyama, Hirofumi Chiba, Yorinobu Sumida, Takaaki Yoshikawa, Chikako Tokoro, Tetsuro Maruyama, Hiroyuki Isayama, Yoshihisa Saida
Digestive Endoscopy.2026;[Epub] CrossRef
Colonic Stenting as a Bridge to Surgery Versus Emergency Resection in Obstructive Colon Cancer: A Systematic Review of Surgical Outcomes
Adrian Marius Silaghi, Catalin Cicerone Grigorescu, Dragos Serban, Laura Carina Tribus, Vlad Denis Constantin, Ion Motofei, Dan Dumitrescu, Corneliu Tudor, Victor Dumitrescu, Bogdan Mihai Cristea, Tudor Mihai Badescu
Journal of Clinical Medicine.2026; 15(12): 4416. CrossRef
Bridging to surgery versus palliation in malignant colorectal obstruction: complication risks and mediation by clinical success
Huanhua Wu, Yuan Wan, Dan Li, Ketong Wu, Bo Zhang
Updates in Surgery.2026;[Epub] CrossRef
Colonic Stenting in Obstructed Colorectal Cancer as a Bridge to Surgery
Sarah Tham, Edwin Yang
Diseases of the Colon & Rectum.2026; 69(7): 1852. CrossRef
Colon stenting for colorectal cancer complicated by intestinal obstruction
S.A. Aliyev, E.S. Aliyev, N.M. Khidirova
P.A. Herzen Journal of Oncology.2026; 15(4): 109. CrossRef
Embracing minimally invasive approaches to colorectal cancer resection
Nan Zun Teo, James Weiquan Li, James Chi Yung Ngu, Tiing Leong Ang
Singapore Medical Journal.2025; 66(Suppl 1): S38. CrossRef

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Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a meta-analysis of randomized controlled trials: Vishali Moond, Priyadarshini Loganathan, Sheza Malik, Dushyant Singh Dahiya, Babu P. Mohan, Daryl Ramai, Michele McGinnis, Deepak Madhu, Mohammad Bilal, Aasma Shaukat, Saurabh Chandan; Clin Endosc 2024;57(6):747-758. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.081

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs).
Methods
Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation.
Results
The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds).
Conclusions
Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

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Hye Kyung Jeon, Gwang Ha Kim
Clinical Endoscopy.2026; 59(1): 1. CrossRef
Does the size of the cold snare affect the outcome of cold snare polypectomy in the colon? A KASID prospective multicenter study
Seongwoo Choi, Jaeyoung Chun, Geunhyuk Choi, Yoojin Lee, Taegeun Gweon, Yunho Jung
Intestinal Research.2026; 24(1): 76. CrossRef
Iatrogenic colon perforation: endoscopic management or surgery
Seung Bum Lee
Clinical Endoscopy.2026; 59(1): 33. CrossRef
Efficacy and safety ranking of endoscopic resection techniques for colorectal polyps: a systematic review and network meta-analysis
Shirui Li, Yue Lei, Yunfan Deng, Sheng Dai, Dehai Xiong, Qi Fan, Xiuyang Li
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Histopathologic outcomes comparison between cold snare polypectomy and cold snare EMR for colorectal polyps: a full-thickness serial sectioning analysis
Ran Chen, Shiya Hong, Jie Gao, Zhi Ni, Peichun Peng, Shuling Lai, Xiaoqing Huang, Yueping Zheng, Qingyong Zhang, Tingting Lin, Bo Hu, Rongchun Zhang
Gastroenterology Report.2026;[Epub] CrossRef
Effective Polypectomy Practice
Malique Delbrune, Thomas Enke, Mohammad Bilal
Gastrointestinal Endoscopy Clinics of North America.2026; 36(4): 719. CrossRef
Cost-Minimization and Procedural Outcomes of Cold Snare Versus Cold Forceps Polypectomy for Small Colorectal Polyps: A Prospective Cohort Study Using Real Institutional Pricing
Güney Özkaya, İsmail Ege Subaşı, Sangar Abdullah, Sertaç Doğan, Şiva Nafez
Healthcare.2026; 14(16): 2656. CrossRef

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390 Download
6 Web of Science
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Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis: Talia F. Malik, Vaishnavi Sabesan, Babu P. Mohan, Asad Ur Rahman, Mohamed O. Othman, Peter V. Draganov, Gursimran S. Kochhar; Clin Endosc 2024;57(3):317-328. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.205

Graphical Abstract Abstract PDF Supplementary Material

Background
/Aims: In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD).
Methods
Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity.
Results
Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%–95.4%; I2=0%), 81.5% (95% CI, 72.5%–88%; I2=43%), and 48.9% (95% CI, 32.1%–65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%–7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%–13%; I2=10%) and 5.3% (95% CI, 3.1%–8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%–18.2%; I2=55%) and 13% (95% CI, 8.5%–19.3%; I2=54%), respectively.
Conclusions
ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.

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High Risk of Colorectal Cancer After High‐Grade Dysplasia in Inflammatory Bowel Disease Patients
Monica E. W. Derks, Maarten te Groen, Lauranne A. A. P. Derikx, Iris D. Nagtegaal, Frank Hoentjen
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Pardhu Neelam Bharath, Thomas Matthews, Pradeep Bhandari, Rupa Banerjee, Noriko Suzuki
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Jesus K. Yamamoto-Furusho, Fausto D. Gutierrez-Herrera
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Sara C. Schiavone, Livia Biancone, Mariasofia Fiorillo, Andrea Divizia, Roberto Mancone, Benedetto Neri
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Shu-Yuan Zhu, Hai-Ping Shen
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Shu-Yuan Zhu, Hai-Ping Shen
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Original Articles

Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis: Rajat Garg, Amandeep Singh, Manik Aggarwal, Jaideep Bhalla, Babu P. Mohan, Carol Burke, Tarun Rustagi, Prabhleen Chahal; Clin Endosc 2021;54(3):379-389. Published online April 29, 2021; DOI: https://doi.org/10.5946/ce.2020.276

Abstract PDF Supplementary Material

Background
/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm.
Methods
We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR.
Results
A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%.
Conclusions
Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

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Underwater endoscopy in the diagnosis and therapy of gastrointestinal neoplasia: focus on the lower gastrointestinal tract
Georgios Kalopitas, Zaheer Nabi, Elisabet Maristany Bosch, Jahnvi Dhar, Jayanta Samanta, Edward J Despott
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Gaurav B Nigam, Yash Kanani, Amol Bapaye, Pradeep Mundre
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Hye Kyung Jeon, Gwang Ha Kim
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Quang D Le, Nhan Q Le, Duc T Quach
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Changwei Duan, Zhen Liu, Xin Wang, Mingjie Zhang, Jianqiu Sheng, Yuqi He, Xianzong Ma
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Kurato Miyazaki, Naohisa Yahagi, Motohiko Kato
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Management of recurrent colorectal polyps post initial polypectomy: a review of the current evidence
Giovanna McGinty, Zeino Zeino
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Raffaele Pellegrino, Giovanna Palladino, Michele Izzo, Ilaria De Costanzo, Fabio Landa, Alessandro Federico, Antonietta Gerarda Gravina
World Journal of Gastrointestinal Endoscopy.2024; 16(12): 647. CrossRef
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Quang Dinh Le, Nhan Quang Le, Duc Trong Quach
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Karl Kwok, Sasan Mosadeghi, Daniel Lew
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Yunho Jung
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Mamoon Ur Rashid, Mohammad Alomari, Sadaf Afraz, Tolga Erim
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Li‐Chun Chang
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Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting: Rajat Garg, Abdelkader Chaar, Susan Szpunar, Babu P. Mohan, Mohammed Barawi; Clin Endosc 2020;53(4):480-486. Published online October 16, 2019; DOI: https://doi.org/10.5946/ce.2019.116

Abstract PDF

Background
/Aims: Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital.
Methods
We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events.
Results
Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal.
Conclusions
Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

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Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
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Giacomo Emanuele Maria Rizzo, Ilaria Tarantino
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Elia Armellini, Flavio Metelli, Andrea Anderloni, Anna Cominardi, Giovanni Aragona, Michele Marini, Fabio Pace
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